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A biopsy is performed to diagnosis some medical conditions, including
cancer. A physician will remove a piece of tissue, which is then sent
to a pathologist. The pathologist will look at the tissue under the microscope,
and may perform additional tests, to determine if there is disease in
the tissue.

Patients may need a biopsy after a mass was seen on physical exam or
radiological imaging. Biopsies may also be performed when other laboratory
tests are abnormal, such as blood counts or Pap smears. A biopsy may be
needed to diagnosis a variety of different conditions, including infection,
inflammatory diseases, or cancer.

The types of biopsies include:

Fine needle aspiration – A small needle is inserted into the
tissue, and cells or fluids are removed. This type of biopsy removes
the smallest amount of tissue. Fine needle aspirations are commonly
performed for thyroid or breast masses.

Incisional biopsy – This type of biopsy removes a slightly
larger piece of tissue to allow the pathologist to have a larger specimen
to examine. A larger tissue sample is necessary in some cases to determine
if disease is present. Often the physician will use a CT scan or ultrasound
to help them locate the tissue they want to biopsy. Incisional biopsies
are taken of the breast, prostate, or outer portion of the lung.

Excisional biopsy – In this procedure, the surgeon is attempting
to remove the entire diseases tissue. Excisional biopsies are performed
with general or local anesthesia because a larger incision into the
skin and tissue is necessary. In addition to making a diagnosis, the
pathologist will look at the borders of the excisional biopsy to be
sure that they are clear of disease. If disease is present at the borders
of the biopsy, it may mean that the tumor was not entirely removed.
In this case the surgeon may decide to perform an additional procedure
to remove more tissue.

Endoscopic biopsy – This type of biopsy if performed with the
help of a fiberoptic endoscope, which allows the physician to visualize
internal organs without making a surgical incision. This type of biopsy
is commonly performed on the gastrointestinal tract, bladder, joints,
chest cavity and abdominal cavity.

Punch biopsy – Dermatologists perform punch biopsies of skin
lesions. A small cylindrical punch is taken of a rash or mass on the
skin.

Bone marrow biopsy – This type of biopsy involves the insertion
of a needle into the bone, commonly the hip, with removal of an aspiration
of cells and a cylindrical piece of tissue. Bone marrow biopsies are
used in the diagnosis of diseases of the blood and bones.

A physician will choose the correct type of biopsy to view the abnormal
tissue. Some masses, such as thyroid nodules, can frequently be diagnosed
with a fine needle aspiration. Others, such as lymph nodes and breast
masses, require more tissue. Patients will be made as comfortable as possible
during the procedure. This may involve local anesthesia, general anesthesia,
or drugs that will cause sedation and relaxation. Fine needle aspirations
and some incisional biopsies can be performed in the doctor office.

The results of a biopsy may be available the following day. In some cases,
the pathologist has to perform special tests that require more time in
order to provide a diagnosis. In this case, it may take several days or
longer to get the results.

Sometimes a biopsy does not provide enough information to determine the
diagnosis. If this is because of an inadequate amount of tissue in the
original biopsy, the physician may want to perform another biopsy. If
a fine needle aspiration or incisional biopsy shows a malignancy, it may
be necessary to perform an excisional biopsy to remove the tumor. Some
chronic conditions, such as hepatitis or kidney transplantation, may require
repeated biopsies to monitor the health of the patient.

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